Infections in general, and respiratory infections (RI) in particular, are highly prevalent in nursing homes, and are one of the major causes of morbidity and mortality in the elderly. The increased incidence of infections in the elderly is multifactorial. A major contributing factor, however, is the well-described decline in cellular and humoral immunity with age. Higher mortality and morbidity, as well as a lesser degree of self-sufficiency, have been reported in elderly people with impaired immune response. The applicants have shown that short- and long-term supplementation with vitamin E significantly improves immune response in elderly humans. Furthermore, preliminary results appear to show that vitamin E-supplemented older individuals had a 30% lower incidence of self-reported infectious diseases compared to a placebo group. Old mice supplemented with vitamin E also have lower lung viral titer following influenza infection compared to old mice consuming an adequate level of vitamin E. It is therefore hypothesized, in this application, that supplementation with vitamin E will enhance the immune response of elderly individuals residing in long-term care facilities; and that this, in turn, will reduce the incidence and severity of RI, which should result in a lower number of sick days and less antibiotic use. The Specific Aims of the project are to determine the effect of one year of vitamin E supplementation on the incidence of RI, total number of sick days and antibiotic use, and in vivo and in vitro indices of cell-mediated immunity. The study will attempt to test the impact of a vitamin E intervention, using clinical and immunological endpoints, in a population of vulnerable long-term nursing home residents. The results are intended to provide basic and applied insight into the mechanisms involved, the goals to be realized, and ways to sharpen the intervention and enhance its impact.